Professional paper - Review paper
Autoimmune pancreatitis

Krznarić Zrnić, Irena; Štimac, Davor; Milić, Sandra (2013)
Metadata
Language Croatian
Title (Croatian)Autoimuni pankreatitis
Title (English)Autoimmune pancreatitis
AuthorKrznarić Zrnić, Irena
Štimac, Davor
Milić, Sandra
Abstract (Croatian)
Autoimuni pankreatitis (AIP) prepoznat je kao zaseban klinički entitet u sklopu kroničnog upalnog procesa gušterače čija je podloga autoimuna bolest. Histološki i klinički razlikuju se dva tipa AIP-a: tip 1 – limfoplazmocitni sklerozirajući pankreatitis sa zahvaćenošću drugih organa i infiltracijom IgG4 pozitivnim stanicama te tip 2 – fibroza glavnog gušteračnog kanala s infiltracijom epitela granulocitima. Ovaj oblik pogađa mlađe ljude, a drugi organski sustavi obično nisu zahvaćeni. Najčešći simptom bolesti je opstruktivni ikterus, dok se oštri bolovi u trbuhu vrlo rijetko javljaju. Približno polovica bolesnika pokazuje neki oblik endokrine i/ili egzokrine disfunkcije gušterače. Iako je antinuklearno antitijelo (ANA) pozitivno u oko 40 % bolesnika, najosjetljivijim i najspecifičnijim markerom danas se još uvijek smatra IgG4. Dijagnoza se postavlja na osnovi dvaju kriterija: tzv. HISORt kriterija koji potječu s Mayo klinike ili Azijskih dijagnostičkih kriterija. Diferencijalno-dijagnostički najvažnije je isključiti karcinom gušterače, endosonografski vođenom biopsijom. Iako se odličan klinički odgovor postiže primjenom kortikosteroida, što je i dijagnostički vrlo značajno, budući da postoji mnogo sličnosti u kliničkoj prezentaciji bolesnika s karcinomom gušterače i AIP-a, još uvijek ne postoji standardizirani terapijski protokol njihove primjene. Danas se ovaj oblik kronične upale gušterače smatra vrlo rijetkom bolesti, no novijim spoznajama vjerojatno će se u budućnosti češće postaviti dijagnoza autoimunog pankreatitisa u bolesnika s akutnim rekuretnim bolovima u trbuhu nejasne etiologije.
Abstract (English)
Autoimmune pancreatitis (AIP) is recognised as a distinct clinical entity, identified as a chronic inflammatory process of the pancreas in which the autoimmune mechanism is involved. Histologycally and clinically we can differ two subsets: type 1 – lymphoplasmacytic sclerosing pancreatitis with other organ involvement and IgG4 positive cells infiltration and type 2- duct centric fibrosis, characterised by granulocyte epithelial lesions without systemic involvement, mostly in younger people. The major symptom at onset is obstructive jaundice, while severe abdominal pain is rare. About half patients with AIP have shown endocrine and exocrine disfunctions. The positive rate of antinuclear antibody is about 40 %, but the most sensitive and specific serologycal marker today is still IgG4. In the diagnosis of AIP two diagnostic criterions are used: the HISORt criteria (Mayo Clinic) and Asian diagnostic criteria. In differential diagnosis it is most importanat to exclude pancreatic cancer by endosonographically guided biopsy. Although high steroid responsiveness has a significant impact on the diagnosis of AIP, since patients with pancreatic cancer and AIP share many clinical features, there’s still no standardised steroid regimen. Even though the frequency of this disease seems to be quite low, by increasing knowledge on this subject in the future it will be possible to diagnose ever – increasing number of patients having acute recurrence of pain from autoimmune pancreatitis.
Keywords (Croatian)autoimuni pankreatitis dijagnostički kriteriji IgG4 liječenje
Keywords (English)autoimmune pancreatitis diagnostic criteria IgG4 treatment
Publication typeprofessional paper - review paper
Publication statuspublished
Peer reviewpeer review
Journal titleMedicina Fluminensis : Medicina Fluminensis
Numbering2013, Vol. 49, No. 4, pp 364-373
ISSN0025-7729
Datepublication: 02.12.2013.
Article URLhttp://hrcak.srce.hr/112516
Scientific fieldBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Internal Medicine
InstitutionUniversity of Rijeka, Faculty of Medicine
(Department of Internal Medicine)
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:183968